PatientMModule - Patient
Clinical Trial SubjectUModule - Patient
General StudyMModule - Study
Patient StudyUModule - Study
Clinical Trial StudyUModule - Study
General SeriesMModule - Series
(0008,0021) Series Date3Date
(0008,0031) Series Time3Time
(0008,0060) Modality1Code String
(0008,103E) Series Description3Long String
(0008,103F) Series Description Code Sequence3Sequence
(0008,1050) Performing Physician's Name3Person Name
(0008,1052) Performing Physician Identification Sequence3Sequence
(0008,1070) Operators' Name3Person Name
(0008,1072) Operator Identification Sequence3Sequence
(0008,1111) Referenced Performed Procedure Step Sequence3Sequence
(0008,1250) Related Series Sequence3Sequence
(0010,2210) Anatomical Orientation Type1CCode String
(0018,0015) Body Part Examined3Code String
(0018,1030) Protocol Name3Long String
(0018,5100) Patient Position2CCode String
(0018,990C) Referenced Defined Protocol Sequence1CSequence
(0018,990D) Referenced Performed Protocol Sequence1CSequence
(0020,000E) Series Instance UID1Unique Identifier
(0020,0011) Series Number2Integer String
(0020,0060) Laterality2CCode String
(0028,0108) Smallest Pixel Value in Series3US or SS
(0028,0109) Largest Pixel Value in Series3US or SS
(0040,0244) Performed Procedure Step Start Date3Date
(0040,0245) Performed Procedure Step Start Time3Time
(0040,0250) Performed Procedure Step End Date3Date
(0040,0251) Performed Procedure Step End Time3Time
(0040,0253) Performed Procedure Step ID3Short String
(0040,0254) Performed Procedure Step Description3Long String
(0040,0260) Performed Protocol Code Sequence3Sequence
(0040,0275) Request Attributes Sequence3Sequence
(0040,0280) Comments on the Performed Procedure Step3Short Text
CR SeriesMModule - Series
Clinical Trial SeriesUModule - Series
General EquipmentMModule - Equipment
General ImageMModule - Image
General ReferenceUModule - Image
Image PixelMModule - Image
Contrast/BolusCModule - Image
Display ShutterUModule - Image
DeviceUModule - Image
SpecimenUModule - Image
CR ImageMModule - Image
Overlay PlaneUModule - Image
Modality LUTUModule - Image
VOI LUTUModule - Image
SOP CommonMModule - Image
Common Instance ReferenceUModule - Image
US Multi-frame ImageCIOD
Secondary Capture ImageCIOD
Multi-frame Single Bit SC ImageCIOD
Multi-frame Grayscale Byte SC ImageCIOD
Multi-frame Grayscale Word SC ImageCIOD
Multi-frame True Color SC ImageCIOD
X-Ray Angiographic ImageCIOD
X-Ray Radiofluoroscopic ImageCIOD
RT Structure SetCIOD
Digital X-Ray ImageCIOD
Digital Mammography X-Ray ImageCIOD
Digital Intra-Oral X-Ray ImageCIOD
RT Beams Treatment RecordCIOD
RT Brachy Treatment RecordCIOD
RT Treatment Summary RecordCIOD
VL Endoscopic ImageCIOD
VL Microscopic ImageCIOD
VL Slide-Coordinates Microscopic ImageCIOD
VL Photographic ImageCIOD
Video Endoscopic ImageCIOD
Video Microscopic ImageCIOD
Video Photographic ImageCIOD
VL Whole Slide Microscopy ImageCIOD
Real-Time Video Endoscopic ImageCIOD
Real-Time Video Photographic ImageCIOD
Grayscale Softcopy Presentation StateCIOD
Color Softcopy Presentation StateCIOD
Pseudo-Color Softcopy Presentation StateCIOD
Blending Softcopy Presentation StateCIOD
Basic Structured DisplayCIOD
XA/XRF Grayscale Softcopy Presentation StateCIOD
Advanced Blending Presentation StateCIOD
Basic Voice Audio WaveformCIOD
Ambulatory ECGCIOD
Hemodynamic WaveformCIOD
Basic Cardiac Electrophysiology WaveformCIOD
Arterial Pulse WaveformCIOD
Respiratory WaveformCIOD
General Audio WaveformCIOD
Real-Time Audio WaveformCIOD
Basic Text SRCIOD
Enhanced SRCIOD
Comprehensive SRCIOD
Key Object Selection DocumentCIOD
Mammography CAD SRCIOD
Procedure LogCIOD
X-Ray Radiation Dose SRCIOD
Spectacle Prescription ReportCIOD
Macular Grid Thickness and Volume ReportCIOD
Implantation Plan SR DocumentCIOD
Comprehensive 3D SRCIOD
Radiopharmaceutical Radiation Dose SRCIOD
Extensible SRCIOD
Acquisition Context SRCIOD
Simplified Adult Echo SRCIOD
Patient Radiation Dose Structured ReportCIOD
Planned Imaging Agent Administration SRCIOD
Performed Imaging Agent Administration SRCIOD
Rendition Selection DocumentCIOD
Enhanced MR ImageCIOD
MR SpectroscopyCIOD
Enhanced MR Color ImageCIOD
Raw DataCIOD
Enhanced CT ImageCIOD
Spatial RegistrationCIOD
Deformable Spatial RegistrationCIOD
Spatial FiducialsCIOD
Ophthalmic Photography 8 Bit ImageCIOD
Ophthalmic Photography 16 Bit ImageCIOD
Stereometric RelationshipCIOD
Hanging ProtocolCIOD
Encapsulated PDFCIOD
Encapsulated CDACIOD
Real World Value MappingCIOD
Enhanced XA ImageCIOD
Enhanced XRF ImageCIOD
RT Ion Beams Treatment RecordCIOD
Ophthalmic Tomography ImageCIOD
X-Ray 3D Angiographic ImageCIOD
X-Ray 3D Craniofacial ImageCIOD
Breast Tomosynthesis ImageCIOD
Enhanced PET ImageCIOD
Surface SegmentationCIOD
Color PaletteCIOD
Enhanced US VolumeCIOD
Lensometry MeasurementsCIOD
Autorefraction MeasurementsCIOD
Keratometry MeasurementsCIOD
Subjective Refraction MeasurementsCIOD
Visual Acuity MeasurementsCIOD
Ophthalmic Axial MeasurementsCIOD
Intraocular Lens CalculationsCIOD
Generic Implant TemplateCIOD
Implant Assembly TemplateCIOD
Implant Template GroupCIOD
RT Beams Delivery InstructionCIOD
Ophthalmic Visual Field Static Perimetry MeasurementsCIOD
Intravascular Optical Coherence Tomography ImageCIOD
Ophthalmic Thickness MapCIOD
Surface Scan MeshCIOD
Surface Scan Point CloudCIOD
Legacy Converted Enhanced CT ImageCIOD
Legacy Converted Enhanced MR ImageCIOD
Legacy Converted Enhanced PET ImageCIOD
Corneal Topography MapCIOD
Breast Projection X-Ray ImageCIOD
Parametric MapCIOD
Wide Field Ophthalmic Photography Stereographic Projection ImageCIOD
Wide Field Ophthalmic Photography 3D Coordinates ImageCIOD
Tractography ResultsCIOD
RT Brachy Application Setup Delivery InstructionCIOD
Planar MPR Volumetric Presentation StateCIOD
Volume Rendering Volumetric Presentation StateCIOD
Content Assessment ResultsCIOD
CT Performed Procedure ProtocolCIOD
CT Defined Procedure ProtocolCIOD
Protocol ApprovalCIOD
Ophthalmic Optical Coherence Tomography En Face ImageCIOD
Ophthalmic Optical Coherence Tomography B-scan Volume AnalysisCIOD
Encapsulated STLCIOD
Encapsulated OBJCIOD
Encapsulated MTLCIOD
RT Physician IntentCIOD
RT Segment AnnotationCIOD
RT Radiation SetCIOD
C-Arm Photon-Electron RadiationCIOD
Tomotherapeutic RadiationCIOD
Robotic-Arm RadiationCIOD
Basic DirectoryCIOD

Built with by Innolitics, a team of medical imaging software developers.

Data synced with official DICOM standard on 12 May 2020. The DICOM Standard is under continuous maintenance, and the current official version is available at DICOM Parts 3, 4, and 6, © NEMA. Please note that the most recent PDF version of the standard is the official reference, and should checked when making technical decisions.

Anatomical Orientation Type Attribute

TypeConditionally Required (1C)
Value Multiplicity1
Value RepresentationCode String (CS)

The anatomical orientation type used in Instances generated by this equipment.

Enumerated Values:



Required if the Patient is an animal and the anatomical Frame of Reference is not bipedal. May be present otherwise. See Section C. and Section C.


If this Attribute is not present, the default human standard anatomical position is used to define the patient orientation of projection images and the Patient-Based Coordinate System of cross-sectional images.

Section C.

C. Patient Orientation

Patient Orientation (0020,0020) relative to the image plane shall be specified by two values that designate the anatomical direction of the positive row axis (left to right) and the positive column axis (top to bottom). The first entry is the direction of the rows, given by the direction of the last pixel in the first row from the first pixel in that row. The second entry is the direction of the columns, given by the direction of the last pixel in the first column from the first pixel in that column. Shall be consistent with Image Orientation (Patient) (0020,0037), if both Attributes are present and Patient Orientation (0020,0020) is not zero length.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, anatomical direction shall be designated by abbreviations using the capital letters:

  • A (anterior)

  • P (posterior)

  • R (right)

  • L (left)

  • H (head)

  • F (foot)

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, anatomical direction shall be designated by the abbreviations using capital letters:

  • LE (Le or Left)

  • RT (Rt or Right)

  • D (Dorsal)

  • V (Ventral)

  • CR (Cr or Cranial)

  • CD (Cd or Caudal)

  • R (Rostral)

  • M (Medial)

  • L (Lateral)

  • PR (Pr or Proximal)

  • DI (Di or Distal)

  • PA (Pa or Palmar)

  • PL (Pl or Plantar)


  1. These abbreviations are capitalized versions of those defined in Smallwood et al for describing radiographic projections. Because of the Code String (CS) Value Representation of Patient Orientation (0020,0020), lowercase letters cannot be used.

  2. It is unfortunate that the conventional veterinary abbreviations (e.g., R for rostral and Rt for right) differ from those chosen for humans for DICOM usage (e.g., R for right), but confusion with in the respective human and animal domains will be reduced. Hanging protocols may need to account for the difference by checking for the correct species.

  3. Smallwood et al define an O (Oblique) abbreviation, which is useful for describing radiographic projections, but do not specify its use for directional terms, and hence it is not included here for describing the row and column directions.

  4. The terms "anterior" and "posterior" are commonly used in vertebrate zoology to describe the cranial and caudal directions respectively, the veterinary terms are used in preference here, also in order to avoid confusion with the contradictory human use of anterior and posterior to mean ventral and dorsal.

  5. For animals other than quadrupeds, for example, birds and fish, it is anticipated that the same nomenclature can be logically extended to describe, for example, wings and fins.

Each value of the orientation Attribute shall contain at least one of these abbreviations. If refinements in the orientation descriptions are to be specified, then they shall be designated by one or two additional abbreviations in each value. Within each value, the abbreviations shall be ordered with the principal orientation designated in the first abbreviations.


  1. For bipeds, since each abbreviation is a single character, no delimiter is required within a single value and none is used. For quadrupeds, though lowercase letters cannot be used, delimiters are not necessary within a single value to eliminate ambiguity, since the abbreviations used are sufficiently distinct, and can be parsed from left to right with a single character of lookahead.

  2. E.g., a medio-lateral oblique projection of the left breast of a human might be encoded with Patient Orientation values of "A\FR" rather than "A\F", since the plane is obliquely inclined such that the columns are directed both downwards and medially, which for a left breast is towards the right, though the downwards direction is the principal column orientation.

  3. E.g., a right dorsal-left ventral oblique view of a quadruped's abdomen might be encoded with Patient Orientation values of "LEV\CD", rather than "LE\CD", since the plane is obliquely inclined such that the rows are directed both to the left and ventrally, though the left direction is the principal row orientation. The abbreviations "LEV", "LE" and "CD", correspond to the designations in Smallwood et al of "LeV", "Le" and "Cd", respectively

Section C.

C. Image Position and Image Orientation

Image Position (0020,0032) specifies the x, y, and z coordinates of the upper left hand corner of the image; it is the center of the first voxel transmitted. Image Orientation (0020,0037) specifies the direction cosines of the first row and the first column with respect to the patient. These Attributes shall be provide as a pair. Row value for the x, y, and z axes respectively followed by the Column value for the x, y, and z axes respectively.

The direction of the axes is defined fully by the patient's orientation.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, the x-axis is increasing to the left hand side of the patient. The y-axis is increasing to the posterior side of the patient. The z-axis is increasing toward the head of the patient.

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, the

  • x-axis is increasing to the left (as opposed to right) side of the patient

  • the y-axis is increasing towards

    • the dorsal (as opposed to ventral) side of the patient for the neck, trunk and tail,

    • the dorsal (as opposed to ventral) side of the patient for the head,

    • the dorsal (as opposed to plantar or palmar) side of the distal limbs,

    • the cranial (as opposed caudal) side of the proximal limbs, and

  • the z-axis is increasing towards

    • the cranial (as opposed to caudal) end of the patient for the neck, trunk and tail,

    • the rostral (as opposed to caudal) end of the patient for the head, and

    • the proximal (as opposed to distal) end of the limbs


  1. The axes for quadrupeds are those defined and illustrated in Smallwood et al for proper anatomic directional terms as they apply to various parts of the body.

  2. It should be anticipated that when quadrupeds are imaged on human equipment, and particularly when they are position in a manner different from the traditional human prone and supine head or feet first longitudinal position, then the equipment may well not indicate the correct orientation, though it will remain an orthogonal Cartesian right-handed system that could be corrected subsequently.

The Patient-Based Coordinate System is a right handed system, i.e., the vector cross product of a unit vector along the positive x-axis and a unit vector along the positive y-axis is equal to a unit vector along the positive z-axis.


If a patient is positioned parallel to the ground, in dorsal recumbency (i.e., for humans, face-up on the table), with the caudo-cranial (i.e., for humans, feet-to-head) direction the same as the front-to-back direction of the imaging equipment, the direction of the axes of this Patient-Based Coordinate System and the Equipment-Based Coordinate System in previous versions of this Standard will coincide.

The Image Plane Attributes, in conjunction with the Pixel Spacing Attribute, describe the position and orientation of the image slices relative to the Patient-Based Coordinate System. In each image frame Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the Patient-Based Coordinate System. RCS and Image Orientation (Patient) (0020,0037) values specify the orientation of the image frame rows and columns. The mapping of pixel location (i,j) to the RCS is calculated as follows:

Equation C. 


  • Pxyz The coordinates of the voxel (i,j) in the frame's image plane in units of mm.

  • Sxyz The three values of Image Position (Patient) (0020,0032). It is the location in mm from the origin of the RCS.

  • Xxyz The values from the row (X) direction cosine of Image Orientation (Patient) (0020,0037).

  • Yxyz The values from the column (Y) direction cosine of Image Orientation (Patient) (0020,0037).

  • i Column index to the image plane. The first column is index zero.

  • Δi Column pixel resolution of Pixel Spacing (0028,0030) in units of mm.

  • j Row index to the image plane. The first row index is zero.

  • Δj Row pixel resolution of Pixel Spacing (0028,0030) in units of mm.

Additional constraints apply:

  1. The row and column direction cosine vectors shall be orthogonal, i.e., their dot product shall be zero.

  2. The row and column direction cosine vectors shall be normal, i.e., the dot product of each direction cosine vector with itself shall be unity.